Monday, April 10, 2006

The man whom I would call the 'Father of Modern Combat PTSD Diagnosis' is dead at the age of 80. Dr. Leonard Neff was a WWII veteran and psychiatrist who'd begun working with Vietnam veterans in the early 1970's. He rose to prominence in dramatic fashion when, in 1974, he persuaded a returning veteran who'd taken hostages to release them following 3 hours of negotiations. The event raised public awareness of the plight of many soldiers returning from Vietnam; it also led Neff to push to include a definition of what today is known as posttraumatic stress disorder to the Diagnostic and Statistical Manual of Mental Disorders.

What seems commonplace now — the idea that a traumatic experience can cause stress that surfaces later — was not as widely understood or clearly defined more than 30 years ago when Neff began his work with veterans. In previous wars, veterans were described as "shell-shocked" or suffering from "combat fatigue," but these descriptions were not true diagnoses, and they seldom carried the moral issue of blame.

Vietnam veterans — many of whom were young and poor — were often seen as the source of their own postwar problems. Some observers argued that the war itself had little to do with the veterans' mental health issues, said Charles R. Figley, a noted psychologist, author and expert in psychological trauma. But Neff, a veteran of World War II, did not share that view.

"Neff wanted to shift the paradigm," said Figley, who heads the Traumatology Institute at Florida State University. "He said no matter who you are under this kind of circumstance — that being war — it will leave a mark, and that mark is predictable and understandable, and we need to do something about it."

Neff was working at what is now the Veterans Affairs psychiatric hospital in Westwood when a then 22-year-old Johnny Gabron took hostages at Griffith Park, recalled Floyd "Shad" Meshad, a Vietnam veteran who was a psychiatric social worker and with Neff when he negotiated the release of the hostages. "At the time we didn't have a diagnosis for Johnny," Meshad said. "We didn't have the term post-traumatic stress disorder."

Although Gabron's story came to define the Vietnam veteran returning with mental health needs due to combat, conflicting accounts of what his experience truly was didn't deter Dr. Neff.

When Neff spoke on behalf of veterans, he did so carrying the weight of his credentials and an international reputation, Figley said. In those contentious years when veterans returned to a sometimes hostile, sometimes ambivalent public, Neff was a bridge. He had the respect of academics, and because of his work with Meshad, a well-known street counselor, he also had the trust of veterans and their advocates who saw him as an ally.

Neff was an innovator who saw the need not only for better treatment but also for appropriate diagnoses. Clearly defining and acknowledging the disorder in the standard reference guide of mental health conditions would mean better treatment and more benefits for veterans.

In 1976 Neff and other professionals presented a working definition of the phenomenon at the annual meeting of the American Orthopsychiatric Assn. But Neff soon left the VA, Meshad said. Behind the scenes, he continued to support the efforts of Meshad, Figley and many others. "His influence and his work and his testimonial about the real world, especially war veterans, was instrumental in making sure [post-traumatic stress disorder] became an actual diagnosis in 1980," said Figley, who was part of a subcommittee of the American Psychiatric Assn. that examined the issue.

Himself a World War II veteran, Neff joined an effort to study the disorder that had described for decades as “shell shock” or “combat fatigue.” He helped officials understand how a traumatic experience in wartime can surface much later, and urged better services for Vietnam veterans.

“He said no matter who you are under this kind of circumstance, that being war it will leave a mark, and that mark is predictable and understandable, and we need to do something about it,” said psychologist Charles R. Figley, who heads the Traumatology Institute at Florida State University.

Dr. Neff passed away on March 26, 2006. Please read his entire obituary to learn more about this remarkable man's life and works.

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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